NPIMap

Individual provider Active NPI

Carol B Peddicord, MD

  • Family Medicine Physician
  • Albany, KY
National Provider Identifier
1912990607
Registry record updated Sep 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
25961 Issued in KY
Practice address
250 Burkesville Rd
Albany, KY 42602-1604
Phone
(606) 387-0323
Fax
(606) 387-0310
NPI assigned
Aug 26, 2005
Last updated
Sep 1, 2022By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 1, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 25961 KY Primary
Internal Medicine Physician 207R00000X 25961 KY

Addresses

Primary practice location

250 Burkesville Rd
Albany, KY 42602-1604

Mailing address

250 Burkesville Rd
Albany, KY 42602-1604
Phone (606) 387-0323

Other practice location 1

102 N Washington St
Albany, KY 42602-1302
Phone (606) 387-2025

Other identifiers 1

IdentifierTypeStateIssuer
64259617MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101202000285 KY Practitioner - Family PracticePractitioner - Internal Medicine 2264628213 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Internal Medicine
Education
Kentucky School of Medicine, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

250 Burkesville Rd
Albany, KY 42602-1604
Phone (606) 387-0323

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal of nail tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Carol B Peddicord MD PLLC Family Medicine CurrentSince May 11, 2015 Accepting new patients
Bowling Green-Warren County Community Hospital Corporation Past Accepting new patients
LP Albany LLC Past Accepting new patients
Bowling Green-Warren County Community Hospital Corporation Past Accepting new patients

Locations

250 Burkesville Rd
Albany, KY 42602
Phone (606) 387-0323

252 Burkesville Rd
Albany, KY 42602
Phone (606) 387-0323

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1125014400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661990400000",
    "number": "1912990607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 BURKESVILLE RD",
            "city": "ALBANY",
            "state": "KY",
            "postal_code": "426021604",
            "telephone_number": "606-387-0323",
            "fax_number": "606-387-0310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 BURKESVILLE RD",
            "city": "ALBANY",
            "state": "KY",
            "postal_code": "426021604",
            "telephone_number": "606-387-0323",
            "fax_number": "606-387-0310"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "102 N Washington St",
            "address_purpose": "LOCATION",
            "city": "Albany",
            "state": "KY",
            "postal_code": "426021302",
            "country_code": "US",
            "telephone_number": "606-387-2025",
            "fax_number": "606-387-0310",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PEDDICORD",
        "first_name": "CAROL",
        "middle_name": "B",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-08-26",
        "last_updated": "2022-09-01",
        "certification_date": "2022-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KY",
            "license": "25961",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "KY",
            "license": "25961",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64259617",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Albany, KY

Sources for this page

Verify at the official NPI Registry.